Friday, June 26, 2009

The Government Owns Your Body

Most at the CBC seem quite happy with this decision - that a 14-year-old-girl's rights were not violated when she was given a forcible blood transfusion against her wishes.

Read that again.

To me, this is one of the most horrifying decisions any court has ever made. The Court has said, essentially, that this girl did not own and control her body. Not even her parents owned and controlled her body. The Manitoba Child and Family Services department did.

For the record, I abhor the idiotic, superstitious nonsense that is religion and what it does to people. But so long as no one is harmed by this choice except the person making the choice or others that consent, then, yes, one is free to believe any mythological baloney they want.

Sometimes being free means letting people make choices that are not those we would make, or even choices that are wrong, or choices that are based on idiotic beliefs.

That girl was not being beaten, not being starved or otherwise abused against her will. She made the choice knowing the probable consequences. And no one but her would pay those consequences.

Ask yourself this - would you want some fundamentalist Christian sect or Muslim sect that somehow attained power to have this same power over your children, the power to invade their physical bodies against your wishes and theirs?

"Saving lives" is the same excuse used by the Chinese government to harvest the organs of Falun Gong prisoners. After all, if it means saving a life - especially the life of a child - why shouldn't the state be able to invade your body against your will?

It is the excuse the fetus fetishists use to try to take away a woman's right to choose or control her body as well.

That is exactly what this decision says - given a good enough reason (decided by them, of course) the state has the right to violate the bodily integrity of someone against their will, or against the will of their parents or legal guardians.

That is horrifying.

Don't let our natural instinct to help a child open us to giving the state the power to control our bodies. That is far worse than one 14-year-old girl making a bad or stupid choice and dying.

16 Comments:

The right to self-determination includes the right to make wrong and stupid decisions (when they impact only ourselves). The last thing anyone needs is Big Daddy Government overruling personal decisions "for our own good". A case like this one, which on the surface seems harmlessly altruistic, is where it starts, but it doesn't end there.

I think you're being a little extreme here. If I'm following the ruling correctly, the point is that the girl in question isn't sufficiently mature to make this decision on her own. So, someone else has to make the decision on her behalf.

Whoever makes that decision should make the decision with her best interests in mind. After all, the only reason the girl has to act through a representative is that she's not mature enough to consider whether or not to pursue her own best interests. Given that, erring on the side of caution suggests that the representative should pursue the child's best interests.

It's quite clear, I think, that acting in her best interests would require giving her the transfusion. (If she were mature enough to make her own decisions, there wouldn't be a problem here; she could decide on her own not to pursue her own best interests. But, as said, she isn't.) Her parents, however, want to make a different decision for her. Hence, the government steps in and acts as her representative, i.e., acts in her best interests.

There's three possible ways to attack this reasoning. (1) Representatives should not always act in the best interests of whomever they represent. But I think this is inherent to the idea of a representative; if someone acts for me but doesn't act in my best interests, then I am conquered, not represented. (2) It was not in her best interests to get the transfusion. I take this to be fairly clearly false, though. (3) She actually was mature enough to make her own decisions. That's probably the stickiest point and would require some seriously careful reading of the decision.

But I don't see any slippery slope at the end of which the state takes control of all our bodies, though.

But ADHR, you make my point precisely. Who gets to decide "the best interests of the child"? The child? The parent(s)?

Nope, as in this case, a faceless bureaucrat who does not know them and does not share their values. They get to decide or override the choice of those actually involved.

But it was to save the child's life right? Well, really, was it? It is not 100% guaranteed. My wife was exposed to Malaria because of some blood she received in a transfusion. How many hemophiliacs contracted AIDS and HIV due to blood transfusions in the 80s?

Receiving a blood transfusion may have been dangerous and not 100% successful. Indeed, I have just listed two secular reasons a child or their parent(s) might refuse a transfusion.

What if it was painful chemotherapy that had a 60% chance of success. Even 85%. And the parents refused, on either religious or other grounds. this ruling says that some agent of the state can over rule the choice - for whatever reason - of the child and the parent(s) in that instance too.

Where does it stop?

What if the socon wing of the CPC manage to gain power. They may decide that forced baptisms of the children of atheists, Muslims and other not Christians is in "the best interests of the child". They may decide that female circumcision is. And by this ruling they can do it over your objections because they deem it "in the best interests of the child" (or removing your child from your heathen household to be taught at a nice Christian residential school far away...what could go wrong?).

If you peel away all the layers and all the emotions about a child in need of medical attention and what this says is that you or I or our children do not own and control our bodies and our lives because if some agent of the state decides to, they can override our choices and make them for us and force us to accept decisions against our will and against our principle.

We have a word for that in English. Its called slavery.

And no, I am not reading too much in to this or being over the top. If not for the idea I stated above - that the state can override your choice to the point of invading your body against your will if it deems it "in your best interests" or necessary - then this case would have had a completely different outcome.

I for one won't stand by and let that happen. The ends do not justify the means.

Sorry, I can't accept the "it's your decision, die with it" attitude when applied to a 14 year old. It takes a village and we all have a responsibility for the children and when parents use religion to convince a child that to put her life at risk that is when we all have to step in to save the child.

I still think you're overreacting. Everyone has an interest in living -- it's defeasible, but everyone has it. This isn't something a political state created.

Adults (who are sane, rational, etc.) are the ones who can defeat that interest, at least for themselves. That is, I can decide that my interest in living is less important than, say, the life of my child. Children can't decide to give up their interest in living. This is part of what it means to be a child -- they aren't at the same level of maturity to make that kind of decision. (They can give up their interests in things of significantly less consequence, but not all lesser interests. For example, although primary education is less significant than life, a child can't give up its interest in primary education. We can legitimately compel children to attend elementary school, despite their protests.) The same applies to physical adults who lack the intellectual capacity to govern their own lives; insofar as they lack the capacity, others make the decisions for them.

So, in many cases, adults represent others and make decisions for them. This is the nature of parenthood, as well as guardianship more generally. But, representatives, as I said, need to act in the best interests of the represented -- not in their own (the representative's) interests, and not for the sake of minor interests over major ones (a choice only the represented could make, if anyone). So, while an individual can give up their interest in living, or simply downplay it, a representative is not entitled to make that decision. Put plainly, it's not the representative's life; they can't be the one to decide to give it up in favour of something else.

In this case, the judgement made by the court was that the parents were not taking their child's interest in living as seriously as they needed to, as representatives. So, another adult was appointed to take that interest fully seriously.

That's the core argument; I don't see that your replies really address it at all.

(1) I'm not clear why passing the decision to a "faceless bureaucrat" is worse than passing it to, say, a grandparent or aunt/uncle. Or even an older sibling, if one existed.

(2) Your points about the success of various treatment options only point out that at the margins, figuring out which course of action actually serves the best interests of a represented child is difficult. It doesn't show that we shouldn't make the decision at all. Again, consider the case of parenthood itself: if your child disagrees with what you want them to do, do you simply throw up your hands and surrender to the child's wishes, or do you assert that you have your child's best interests in mind and your decision will govern? (There are cases and cases, of course, but if even sometimes you override your child's decision, then you are accepting the basic structure here.)

(3) Your point about the socon lunatics is, as far as I can see, irrelevant. At least the relevance is very unclear. I don't see how we go down that slippery slope. There's a clear difference between deeming something to be in someone's interest and it actually being in their interest. We might disagree amongst ourselves as to what exactly is an actual interest, but the difference still remains. In your case, something is simply dubbed in someone's interest, without acknowledging any concerns to the contrary and without defending the claim that it actually is in someone's interest. In the case actually at hand, we're talking about the interest in living, which everyone seems to have.

(4) It is not slavery to force a child to accept an adult's decision. It's not even slavery to force an adult to accept another adult's decision. I don't just mean the cases involving less than competent adults. For example, when one loses a democratic vote after agreeing to accept the outcome of the vote, one can legitimately be compelled into accepting the decision, regardless of whether one now wants to back out of the agreement. The backing out is not legitimate, in light of the previous agreement; hence, adults can be compelled without thereby being slaves.

(5) Of course the ends sometimes justify the means. If I have as my end the obtaining of a cup of coffee, turning on the coffee maker is justified by that end -- turning on the coffee maker is a sensible means to achieve my end of obtaining a cup of coffee. What else is there in that simple case that justifies my means but the end? (And, for that matter, shows that, say, throwing the cat against the wall is an unjustified means?)

(6) I'd be interested in knowing the other ways to save the girl's life without overriding her and her parents' decision. If there are other options, then of course they should be considered. But I don't see what these other options are.

[Sorry for the two comments, but apparently Blogger now has a character limit on comments.]

While you make some good points, they all go to the ends, which I do not disagree with.

But at the core, you are advocating that the government have to power to invade a person's body against their will. The excuse this time is to "save their life". What will if be next time?

I think many people have the whole religious aspect clouding their judgment.

How about this: what if the child and parents wanted to refuse the transfusion because they did not trust the blood supply? Not unreasonable given the results of the Krever Commission. Would you still be for then forcing a medical procedure on them, against their will?

Sorry but while I agree that children may not be mature enough to make their own decisions (except that may debatable in this case - I think a 14 year old is plenty mature enough) the last line of resort, like it or not, is then the parents. And unless that parent is physically harming the child, there is no reason for anyone else to interfere.

To put it bluntly, saving the life of a single child is not worth the price of giving up absolute authority over my bodily integrity and those of my kids.

If you wish to save the lives of kids in in idiot cults, with moron parents, you must find a way other than allowing the state to forcibly invade their bodies against their will.

Period.

It really is just as simple as that and sorry, but that is exactly what this case says. And my socon example is completely relevant, because if it is ok for the state to invade someones body for any reason they deem fit, then that applies to whatever reasons are made up by the people who control the state. That you happen to agree with the reasons this time, does not mean you always will. But the state will retain the power just the same.

I am not willing to give the state or any government that kind of power, even when I might agree with the ultimate outcome.

No, Mike, you are simply and completely overreacting to this story. It has nothing to do with "ownership" of one's body and everything to do with informed consent as it pertains to consent to medical procedures. This does NOT have any kind of broader interpretation. Simply put, to give informed consent, an individual must do so voluntarily, must be competent, and must be informed. While competence is presumed for adults 18+, this is not the case for minors, who must pass a capacity test (maturity, intelligence, independence); if they do, they are deemed "mature minors" and can give informed consent (or refusals), BUT this is not absolute and can be overrided by *existing* child welfare legislation in many provinces and the welfare principle - namely that treatment must be in the patient's best interest.

What's more, this ruling merely confirms the legal standing of current legislation that applies to minors exclusively. It has absolutely nothing to do with adult patients, nor indeed does it pertain to legal questions outside of informed consent for medical procedures.

And, frankly, your comments about the bloody supply are ludicrous and inflammatory. It's not 1984 and we aren't still trying to figure out what causes AIDS. In any case, everything carries risks to some degree - nothing can ever be 100% effective or safe, but refusing a transfusion on those grounds who be a classic example of uninformed consent.

On the other hand, if you want to argue that minors should have presumed competence or that child welfare legislation should be repealed for whatever reason, go right ahead - it makes this no less an overreaction.

No, I am not overreacting, I am merely exposing the underlying principle upon which this decision is based. For all your sophistry about "informed consent" and how it only applies to "children", at the end of the day, the court ruled that a person can have their bodily integrity violated by the state against their will or against the will of their parent(s) or legal guardians if the agents of that state deem it necessary. Without that principle - that a third party can control your body if they deem it necessary - then the court could not have come to the conclusion it did.

Simply put, to give informed consent, an individual must do so voluntarily, must be competent, and must be informed.

Is it your assertion that the girl or the parents were unaware of the possible consequences? Were the parents not competent if the girl was not? What exactly does "informed consent" mean other than after being properly informed, the patient or their competent guardian can still refuse treatment?

BUT this is not absolute and can be overrided by *existing* child welfare legislation in many provinces and the welfare principle - namely that treatment must be in the patient's best interest.

Ah but there's the rub and the point of my post - it seems even after being informed and properly competent, if a patient or guardian chooses NOT to consent, for whatever reason, someone else who is unrelated can decide what is in the patient's "best interests". Isn't that the purpose of informed consent - to allow the patient or their competent guardian's decide what is in their own "best interests"?

So, if one peals away the layers, at the bottom this states that the patient and the guardian can have all of the "informed consent" they want, but if some one still doesn't like a decision someone else made about their own lives and bodies, then the state via one of its agents can still override that informed choice and act against that person's will to the point of physically invading their body.

And, frankly, your comments about the bloody supply are ludicrous and inflammatory. It's not 1984 and we aren't still trying to figure out what causes AIDS. In any case, everything carries risks to some degree - nothing can ever be 100% effective or safe, but refusing a transfusion on those grounds who be a classic example of uninformed consent.

Clearly you didn't understand the point of that passage then. Most people were making this out to be about religion. I merely posited that there could be plausible, secular, non-religious based reasons someone could reasonably refuse a blood transfusion. I personally have no issues at all with the safety of the blood supply in Canada, even after my wife was exposed to malaria due to a transfusion with contaminated blood...in 2003.

But again, if a person who held this belief WAS informed and STILL choose not to undergo a transfusion, you, and this ruling are saying that because they still don't agree, then the state can ignore their lack of consent and invade their body against their will. Or the body of their child.

That seems to make the entire idea of "informed consent" a sham, since even if after being informed, it doesn't matter if you do not consent, the state will find a reason to force you to do it anyway.

Now this seems all well and good when discussing a kid needing a blood transfusion or chemo, but it is the exact principle used in some places for forced female circumcision and forced organ harvesting. The exact same. We just sugar coat it a little more.

On the other hand, if you want to argue that minors should have presumed competence or that child welfare legislation should be repealed for whatever reason, go right ahead - it makes this no less an overreaction.

I want to argue that the ends - child welfare - do not justify the means - forcibly invading someone's bodily integrity against their will or the will of their parent(s) or guardian.

There are better ways - more education, a wider variety of choices, procedures that may not require blood...anything short of holding a young girl down and forcing foreign fluids into her body against her will and against those of her parent's.

And at the end of the day, if that doesn't work, you must accept that these people should be allowed to make a stupid decision and live (or die) with the consequences. You would expect no less if it were you and your child.

As for the effect on child welfare, I suspect this will have a negative effect. Kids of parents who are Jehovah's Witnesses, or any other group, who do not believe in blood transfusions (or other medical procedures) simply will not take their kids to the hospital when they are ill, for fear of having their religious or other beliefs violated. Its clear they cannot refuse treatment, so they simply won't seek it, on the off chance that the treatment might include such procedures they cannot for any reason submit to. And in the end, we will have more kids dying at home of very treatable diseases, because parents are afraid to take their kids to hospitals that won't respect their choices and beliefs.

Welcome to the world of unintended consequences. They usually pop up when people's free choice is taken from them.

The thing is, we can change just one detail and it would make the state's actions right: what if the child in question was two years old instead of fourteen? If the parents refused to give their child life-saving surgery, the state would have an obligation to step in and protect the child. Because the child is clearly too young to make his or her own decisions, and the parents have clearly reneged on their obligation to provide proper care for their child.

Emotionally, the situation gets cloudy because a 14-year-old is saying 'no' rather than a 2-year-old, and a 14-year-old unquestionably has a greater ability to make his or her opinions known. But by law, I believe the fourteen-year-old has the same legal standing as a two-year-old. And so the state's obligation is clear.

What needs to change is the age of consent. We already have ludicrous things happening in the States where young couples experimenting in sexual activity have been picked up by authorities and charged in the statutory rape of each other. We must do what we can to eliminate such silliness. Someone over twelve should have a greater say over what happens to his or her body than they currently have.

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